Vietnam has a nutrition problem that sounds like a contradiction: too many of its children are underweight, but at the same time, more and more children are becoming overweight every year.

This could seem like two separate public health issues, but they are actually connected, because both are the result of poor diets. Historical fears of undernutrition may have pushed Vietnamese to overcompensate in their eating habits, swinging the problem in the opposite direction, to overnutrition.

It’s a phenomenon not unique to Vietnam. Countries across the developing world are juggling a history of food insecurity against a rising availability of meat, milk, fast food, and other junk food.

Today, fewer Vietnamese are going hungry. The country is often touted as a shining example of the success of the eight U.N. Millennium Development Goals, the first of which is to eradicate extreme poverty and hunger.

“The food poverty rate reduced by more than two-thirds, from 24.9 percent in 1993 to 6.9 percent in 2008” in Vietnam, according to the U.N. website.

And yet, starvation is very much a part of living memory.

Le Thi My Phuong, a mother of two, was born in 1976. She missed the war but lived to see its consequences, including bouts of famine that lasted into the 1980s. The food rationing of that era left psychological effects among many Vietnamese, who then wanted to make sure their children never lacked food. My Phuong said she likes to give her children a cocoa product that’s popular in Vietnam, mixing chocolate powder and milk.

“I don’t think it’s a bad thing,” said My Phuong, who described herself as a merchant. “I want them to develop and be tall, I don’t want them to be too skinny.”

Symbol of wealth

As in other developing countries, having plump children is seen as a symbol of wealth here, because it shows parents can afford to feed their offspring well. This comes at a time when fast food, such McDonald’s which arrived in February, gains popularity, and soft drinks remain cheap after soda lobbies helped kill a proposal to tax fizzy drinks in July.

Along with little public interest in physical exercise, these are part of the reason that UNICEF, the U.N. Children’s Fund, estimates that the rate of overweight children in Vietnam increased six-fold since 2000.

But perhaps a more insidious factor is milk. The dairy drink has a special place in the country, because it used to be somewhat rare among mostly lactose-intolerant Vietnamese. But the years of starvation and stunting drove policymakers in search of a dietary solution. One of them was milk, seen as a simple source of nutrients that could be easily distributed nationwide. Officials promoted a milk campaign, especially through Vinamilk, a Forbes-ranked corporation that is partly state-owned and one of the most powerful in the country. Dairy companies bombarded consumers with TV commercials that featured smiling children who drank milk to grow tall and chubby.

As My Phuong demonstrates, the marketing worked and Vietnamese came to see milk as a staple for children alongside the more traditional rice and noodles. Aside from vitamin D and calcium, people weren’t discussing other components of milk, such as hormones, antibiotics, allergens, fat, and sugar - especially lactose, which humans have a hard time digesting.

Roger Mathisen, a nutrition specialist at UNICEF in Hanoi, said part of the problem is that Vietnamese see advertising as a source of facts, “not realizing that it is propaganda.”

In recent years, Vietnam pulled back on its milk campaign, though the government still raised a lot of eyebrows in 2013 when it announced a push to make citizens taller through better nutrition.

The state now bans ads for formula targeting infants under two years old, though other milk marketing is still going strong.

“The government budget to promote healthy living is so minimal compared to the marketing budgets of these companies,” Mathisen said.

Preventive care

He suggested that, while the government can’t compete dollar for dollar against corporate ads, it can use regulatory tools to improve public health. For example, medical practitioners tend to favor treatment and pharmaceuticals because that’s what health insurance reimburses. But Mathisen said that policymakers could revise insurance rules to prioritize preventive care, such as counseling first-time mothers to choose breastfeeding over milk formula.

But consumption is not the only factor affecting obesity rates. Observers say that as Vietnam rapidly urbanizes, citizens are getting much less physical activity in cramped cities than they did in the countryside. Many of them are trading farm labor for stationary office jobs. “The obesity rate in urban areas is three times greater than in rural areas," the country's General Statistics Office wrote in a 2011 report, noting rates of 8 percent and 3.1 percent, respectively.

Michael Waibel, editor of an urban development book “Ho Chi Minh: MEGA City”, said urban planners should create more “green spaces” and encourage residents to exercise in public.

“The city is not very pedestrian-friendly and there are no bicycle lanes to my knowledge,” Waibel said on a recent trip to Ho Chi Minh City.

Two birds

While officials have paid little attention to physical activity, it’s understandable that they remain preoccupied with undernourishment. Vietnam still has a stunting rate of 28 percent among children, according to Unicef. Stunting is especially prevalent among rural populations, while obesity prevails among city dwellers, so government policy has to differ by region.

But Mathisen said that there’s a way to tackle both forms of malnutrition at once. Vietnam has to educate people about eating balanced diets because “food diversity protects against both undernutrition and overweight [problems],” Mathisen said. “You actually have one good solution that’ll address both.”